血压变异性与原发性高血压患者心房颤动的关系
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摘要
目的:探讨血压变异性与原发性高血压患者心房颤动(房颤)的关系。方法:高血压患者233例,其中房颤组81例,非房颤组152例,采集临床基线资料、动态血压、超声心动图等参数;应用logistic回归及受试者工作特征(ROC)曲线分析血压变异性对房颤的影响。结果:房颤组24 h加权收缩压标准差、24 h加权舒张压标准差和脉压明显高于非房颤组(P<0.05)。Logistic回归分析显示年龄、尿酸、体重指数、24 h加权收缩压标准差、24 h加权舒张压标准差、脉压、左房内径、左室质量指数是房颤的独立危险因素;ROC曲线显示24 h加权收缩压标准差、24 h加权舒张压标准差[曲线下面积(95%CI)分别为0.690(0.619～0.761)和0.708(0.642～0.774)]对于房颤发生的预测比脉压[曲线下面积(95%CI)为0.650(0.576～0.725)]更有价值。结论:24 h加权收缩压标准差、24 h加权舒张压标准差和脉压是房颤的独立危险因素;24 h加权收缩压和舒张压标准差对于房颤发生的预测更具有价值。
Aim:To investigate the correlation between blood pressure variability and atrial fibrillation(AF) in patients with essential hypertension.Methods:A retrospective study of 233 patients with essential hypertension,including 81 patients in the AF group and 152 in the AF-free group was performed.The patients accepted ambulatory blood pressure monitoring and echocardiography examination,and their baseline data were recorded.The effect of blood pressure variability on AF was analyzed using logistic regression and receiver operating characteristic(ROC) curves.Results:It was shown that24 h weighted standard deviation of systolic blood pressure,24 h weighted standard deviation of diastolic blood pressure,and in the AF group pulse pressure were significantly higher than those in the AF-free group(P<0.05).Logistic regression analysis showed age,uric acid,body mass index,and 24 h weighted standard deviation of systolic blood pressure,24 h weighted standard deviation of diastolic pressure,pulse pressure,left atrium diameter,and left ventricular mass index were independent risk factors for AF;ROC curves showed area under the curve(95% CI) of 24 h weighted standard deviation of systolic blood pressure and 24 h weighted standard deviation of diastolic pressure was 0.690(0.619-0.761),0.708(0.642-0.774) which was more valuable for the diagnosis of AF than pulse pressure [area under the curve(95%CI) of 0.650(0.576-0.725)].Conclusion:24 h weighted standard deviation of systolic blood pressure,24 h weighted standard deviation of diastolic blood pressure,and pulse pressure are independent risk factors for AF;24 h weighted standard deviation of diastolic blood pressure and systolic blood pressure have greater diagnostic value for AF than pulse pressure.
Aim:To investigate the correlation between blood pressure variability and atrial fibrillation(AF) in patients with essential hypertension.Methods:A retrospective study of 233 patients with essential hypertension,including 81 patients in the AF group and 152 in the AF-free group was performed.The patients accepted ambulatory blood pressure monitoring and echocardiography examination,and their baseline data were recorded.The effect of blood pressure variability on AF was analyzed using logistic regression and receiver operating characteristic(ROC) curves.Results:It was shown that24 h weighted standard deviation of systolic blood pressure,24 h weighted standard deviation of diastolic blood pressure,and in the AF group pulse pressure were significantly higher than those in the AF-free group(P<0.05).Logistic regression analysis showed age,uric acid,body mass index,and 24 h weighted standard deviation of systolic blood pressure,24 h weighted standard deviation of diastolic pressure,pulse pressure,left atrium diameter,and left ventricular mass index were independent risk factors for AF;ROC curves showed area under the curve(95% CI) of 24 h weighted standard deviation of systolic blood pressure and 24 h weighted standard deviation of diastolic pressure was 0.690(0.619-0.761),0.708(0.642-0.774) which was more valuable for the diagnosis of AF than pulse pressure [area under the curve(95%CI) of 0.650(0.576-0.725)].Conclusion:24 h weighted standard deviation of systolic blood pressure,24 h weighted standard deviation of diastolic blood pressure,and pulse pressure are independent risk factors for AF;24 h weighted standard deviation of diastolic blood pressure and systolic blood pressure have greater diagnostic value for AF than pulse pressure.
引文
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[12]KARIO K,HOSHIDE S,UCHIYAMA K,et al.Dose timing of an angiotensinⅡreceptor blocker/calcium channel blocker combination in hypertensive patients with paroxysmal atrial fibrillation[J].J Clin Hypertens,2016,18(10):1036
[13]KODANI E,ATARASHI H,INOUE H,et al.Impact of blood pressure control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation:a subanalysis of the J-RHYTHM Registry[J].J Am Heart Assoc,2016,5(9):e004075
[2]杨华志,王东方,苗云江.大量饮酒对高血压病人血压的影响[J].海南医学,2004,15(9):9
[3]刘骏,杜瑞雪,王亮,等.高血压患者血压变异性临床研究进展[J].中华老年心脑血管病杂志,2017,19(10):1103
[4]刘新灿,王红辉,李胜军,等.高血压晨峰对高血压患者脂蛋白相关磷脂酶A2及冠状动脉钙化积分的影响[J].郑州大学学报(医学版),2014,49(3):384
[5]王海军,司全金,李开亮,等.老年原发性高血压患者血压变异性对新发心房颤动的影响[J].中华老年心脑血管病杂志,2017,19(3):228
[6]彭威,纪焕春.老年全髋置换患者血压、心率变异性与围术期新发房颤的相关性[J].中国老年学杂志,2015,35(19):5490
[7]PIERDOMENICO SD,LAPENNA D,CUCCURULLO F.Risk of atrial fibrillation in dipper and nondipper sustained hypertensive patients[J].Blood Press Monit,2008,13(4):193
[8]LARSTORP AC,ARIANSEN I,GJESDAL KA,et al.Association of pulse pressure with new-onset atrial fibrillation in patients with hypertension and left ventricular hypertrophy the losartan intervention for endpoint(life)reduction in hypertension study[J].Hypertension,2012,60(2):347
[9]PROIETTI M,ROMITI GF,OLSHANSKY BA.Systolic blood pressure visit-to-visit variability and major adverse outcomes in atrial fibrillation the AFFIRM study(atrial fibrillation follow-up investigation of rhythm management)[J].Hypertension,2017,70(5):949
[10]COULSON JM.The relationship between blood pressure variability and catecholamine metabolites:a pilot study[J].J Hum Hypertens,2015,29(1):50
[11]NATTEL S,HARADA M.Atrial remodeling and atrial fibrillation:recent advances and translational perspectives[J].J Am Coll Cardiol,2014,63(22):2335
[12]KARIO K,HOSHIDE S,UCHIYAMA K,et al.Dose timing of an angiotensinⅡreceptor blocker/calcium channel blocker combination in hypertensive patients with paroxysmal atrial fibrillation[J].J Clin Hypertens,2016,18(10):1036
[13]KODANI E,ATARASHI H,INOUE H,et al.Impact of blood pressure control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation:a subanalysis of the J-RHYTHM Registry[J].J Am Heart Assoc,2016,5(9):e004075